Am J Psychiatry 1996; 153:752-758
Copyright © 1996 by American Psychiatric Association
The borderline patient's intolerance of aloneness: insecure attachments and therapist availability
JG Gunderson
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
OBJECTIVE: This article describes the clinical and theoretical significance
of intolerance of aloneness for patients with borderline personality
disorder. It is intended to make their treatment more effective and less
burdensome. METHOD: Clinical observations from the author's more than 9,000
hours of psychotherapeutic work and 500 psychotherapy consultations with
borderline patients are synthesized with findings of relevant empirical
studies and attachment theory. RESULTS: Intolerance of aloneness is a
deficit that is associated with the borderline patient's typical clinging
and attention-seeking or detached forms of attachment. Suggestions are
given for ways in which clinicians can respond to these dysfunctional
attachment behaviors to diminish the patient's feared aloneness without
encouraging unnecessary regressions. A framework for understanding the
long-term attachment processes required to correct this deficit is offered.
CONCLUSIONS: Intolerance of aloneness is a core deficit in borderline
patients that can become less handicapping with reliable, but not
excessive, responsiveness of the therapist.
